Provider Demographics
NPI:1013691500
Name:FERRINO, MICHAEL JOSEPH
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JOSEPH
Last Name:FERRINO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4105 S ROUTE 62
Mailing Address - Street 2:
Mailing Address - City:KENNEDY
Mailing Address - State:NY
Mailing Address - Zip Code:14747-9784
Mailing Address - Country:US
Mailing Address - Phone:716-498-8101
Mailing Address - Fax:
Practice Address - Street 1:141 CHAUTAUQUA AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NY
Practice Address - Zip Code:14750-1278
Practice Address - Country:US
Practice Address - Phone:716-763-7665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025612225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty